Qualifications

• Must have a Bachelor’s degree or equivalent
• Excellent English written and oral communication skills
• Portuguese written and oral skill is a Must
• Exceptional organizational and time-management focus
• Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
• 1+ years of customer service experience analyzing and solving customer problems required; call center experience a PLUS
• Ability to perform in a high volume, fast paced call center environment
• Proven ability to work independently as well as a productive member of a team
• Intermediate proficiency in Microsoft Office Suite; high level capacity to multitask independently and on a computer
• Knowledge of Medical Terminology a PLUS

Conditions/Requirements:

• Work in 24 x 7 rotation shifts.
• 5 days a week.
• In split shifts (some hours in the morning and remaining hours in the afternoon or evening) and Public Holidays

Main Duties / Responsibilities
 

• A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
• Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
• In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
• Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claims payments.
• Answering queries related to Policy coverage criteria and guidelines.
• Complying with federal, state, and company regulations and policies.
• Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
• Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.
• Performing other clerical tasks, as required.

Claims Processor Requirements:

• Medical Qualification Background will be an added advantage.
• At least 2 years of experience as a claim’s processor or in a related role.
• Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details

Qualifications

• Must have a Bachelor’s degree or equivalent
• Excellent English written and oral communication skills
• French written and oral skill is a Must
• Exceptional organizational and time-management focus
• Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
• 1+ years of customer service experience analyzing and solving customer problems required; call center experience a PLUS
• Ability to perform in a high volume, fast paced call center environment
• Proven ability to work independently as well as a productive member of a team
• Intermediate proficiency in Microsoft Office Suite; high level capacity to multitask independently and on a computer
• Knowledge of Medical Terminology a PLUS

Conditions/Requirements:

• Work in 24 x 7 rotation shifts.
• 5 days a week.
• In split shifts (some hours in the morning and remaining hours in the afternoon or evening) and during public holidays